Healthcare Provider Details

I. General information

NPI: 1134612674
Provider Name (Legal Business Name): KENNY LUC DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2018
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 S BARRANCA AVE STE 555
COVINA CA
91723-2791
US

IV. Provider business mailing address

1237 LAFAYETTE ST
SAN GABRIEL CA
91776-3303
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-2273
  • Fax: 818-357-2505
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number291381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: